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author:("Singh, senita")
1.  A journey into insidious world of MALT lymphoma of the ileum: from the beginning to the end 
Introduction
Lymphoma of the mucosa-associated lymphoid tissue (MALT) has been used to describe a marginal zone B-cell lymphoma derived from gastrointestinal lymphoid tissue. mucosa-associated lymphoid tissue lymphoma (MALToma) of the ileum are extremely rare and only few reports with endoscopic features have been reported.
Case study
We present a 55-year-old male patient with history of abdominal pain and loss of appetite since 2½ years. Abdomino-pelvic ultrasonography was normal, but computed tomography (CT) scan of the abdomen showed, dilated segment of ileum containing both contrast and debris. He underwent segmental resection of ileum associated with stricture site, histopathology of which revealed MALToma of ileum. Patient was subsequently treated with low dose chemotherapy and strictly followed up.
Discussion
Primary treatment possibility should be considered as the treatment of H. pylori infection while surgical resection for superficial lesions followed by low dose chemotherapy is recommended. The present case report explore MALToma of the GI tract, its diagnostic criterions, role of radiological and pathological tools, various investigative techniques and role of surgery and chemotherapy in such cases.
doi:10.3978/j.issn.2078-6891.2014.063
PMCID: PMC4226819  PMID: 25436136
Mucosa-associated lymphoid tissue lymphoma (MALToma) of ileum; MALT lymphomas (MALToma) of the stomach; anastomosis
2.  MCM Paradox: Abundance of Eukaryotic Replicative Helicases and Genomic Integrity 
As a crucial component of DNA replication licensing system, minichromosome maintenance (MCM) 2–7 complex acts as the eukaryotic DNA replicative helicase. The six related MCM proteins form a heterohexamer and bind with ORC, CDC6, and Cdt1 to form the prereplication complex. Although the MCMs are well known as replicative helicases, their overabundance and distribution patterns on chromatin present a paradox called the “MCM paradox.” Several approaches had been taken to solve the MCM paradox and describe the purpose of excess MCMs distributed beyond the replication origins. Alternative functions of these MCMs rather than a helicase had also been proposed. This review focuses on several models and concepts generated to solve the MCM paradox coinciding with their helicase function and provides insight into the concept that excess MCMs are meant for licensing dormant origins as a backup during replication stress. Finally, we extend our view towards the effect of alteration of MCM level. Though an excess MCM constituent is needed for normal cells to withstand stress, there must be a delineation of the threshold level in normal and malignant cells. This review also outlooks the future prospects to better understand the MCM biology.
doi:10.1155/2014/574850
PMCID: PMC4217321  PMID: 25386362
3.  Epigenetic Silencing of CXCR4 Promotes Loss of Cell Adhesion in Cervical Cancer 
BioMed Research International  2014;2014:581403.
In the network of chemokine signaling pathways, recent reports have described the SDF-1α/CXCR4 axis and its role in cancer progression and metastasis. Interestingly, we found downregulation of CXCR4 at both transcript and protein level in cervical cancer cell lines and primary tumors. We also found CXCR4 promoter hypermethylation in cervical cancer cell lines and primary biopsy samples. DNA hypomethylating drug 5-AZA-2′-deoxycytidine and histone deacetylase inhibitor Trichostatin A treatments in cell lines reactivate both CXCR4 transcription and protein expression. Cell adhesion assay demonstrated that autocrine SDF-1α promotes the loss of cell adhesion while paracrine SDF-1α predominantly protects the normal cervical cells from loss of cell adhesion. Cervical cancer cell line C-33A having increased expression of CXCR4 after TSA treatment showed increased cell adhesion by paracrine source of SDF-1α in comparison to untreated C-33A. These findings demonstrate the first evidence that epigenetic silencing of CXCR4 makes the cells inefficient to respond to the paracrine source of SDF-1α leading to loss of cell adhesion, one of the key events in metastases and progression of the disease. Our results provide novel insight of SDF-1α/CXCR4 signaling in tumor microenvironment which may be promising to further delineate molecular mechanism of cervical carcinogenesis.
doi:10.1155/2014/581403
PMCID: PMC4119908  PMID: 25114911
4.  Primary Ewing's sarcoma of cervical vertebra: An uncommon presentation 
Asian Journal of Neurosurgery  2014;9(2):99-101.
Ewing's sarcoma is a malignant primary bone tumor primarily seen in the long bones. Primary Ewing's sarcoma of the cranium is quite uncommon occurring in 1% of the cases. We report the occurrence of this rare lesion in a 24-year-old male presenting with progressively increasing swelling in left mastoid region mimicking a mastoid abscess which was later diagnosed on Fine needle aspiration cytology (FNAC) as a small round cell tumor as Ewing's sarcoma. Contrast enhanced computed tomography (CECT) revealed a typical moth eaten appearance in the first and second cervical vertebra.
doi:10.4103/1793-5482.136725
PMCID: PMC4129586  PMID: 25126127
Ewing's sarcoma; primary cervical vertebra tumor; tumor of atlas vertebra
5.  Composition, In Vitro Antioxidant and Antimicrobial Activities of Essential Oil and Oleoresins Obtained from Black Cumin Seeds (Nigella sativa L.) 
BioMed Research International  2014;2014:918209.
Gas chromatography-mass spectrometry (GC-MS) analysis revealed the major components in black cumin essential oils which were thymoquinone (37.6%) followed by p-cymene (31.2%), α-thujene (5.6%), thymohydroquinone (3.4%), and longifolene (2.0%), whereas the oleoresins extracted in different solvents contain linoleic acid as a major component. The antioxidant activity of essential oil and oleoresins was evaluated against linseed oil system at 200 ppm concentration by peroxide value, thiobarbituric acid value, ferric thiocyanate, ferrous ion chelating activity, and 1,1-diphenyl-2-picrylhydrazyl radical scavenging methods. The essential oil and ethyl acetate oleoresin were found to be better than synthetic antioxidants. The total phenol contents (gallic acid equivalents, mg GAE per g) in black cumin essential oil, ethyl acetate, ethanol, and n-hexane oleoresins were calculated as 11.47 ± 0.05, 10.88 ± 0.9, 9.68 ± 0.06, and 8.33 ± 0.01, respectively, by Folin-Ciocalteau method. The essential oil showed up to 90% zone inhibition against Fusarium moniliforme in inverted petri plate method. Using agar well diffusion method for evaluating antibacterial activity, the essential oil was found to be highly effective against Gram-positive bacteria.
doi:10.1155/2014/918209
PMCID: PMC3933240  PMID: 24689064
6.  Adenoid Cystic Carcinoma of Cervix: Treatment Strategy 
Adenoid Cystic Carcinoma (ACC) of cervix behaves aggressively and it has a propensity for local infiltration, invasion in lymphatic vessels as well as perineural spaces, with subsequent haematogenous spread. In advanced disease (Stage III and IV), outcome is invariably poor. Moreover, these cases have a high tendency to recur locally and also to metastasize to distant sites. There are no standard treatment protocols because of rarity of disease. The guidelines for its management are established similarly as for staged squamous cell carcinoma of cervix. Therefore, recommended treatment in advanced disease is aggressive multimodality treatment, which includes chemotherapy and radiotherapy. We are presenting a case of adenoid cystic carcinoma of cervix in 55 years old patient, staged as III B. The patient was treated with concomitant radiotherapy and chemotherapy. The patient responded well to treatment and is disease free, three years after treatment.
doi:10.7860/JCDR/2013/5874.3623
PMCID: PMC3879875  PMID: 24392415
Adenoid cystic carcinoma; Cervical carcinoma; Chemotherapy
7.  Role of cyclin D1 immunoreactivity and AgNOR staining in the evaluation of benign and malignant lesions of the prostate 
Prostate International  2014;2(2):90-96.
Purpose:
Prostatic carcinoma is a common and growing public health problem. Histological evaluation is fairly adequate for assessing tumor differentiation, but tumor proliferative activity is difficult to measure. Increasing evidence suggests that the factors controlling cell cycle progression also modulate the rate of ribosome biogenesis. Despite the influence of cyclin D1 and argyrophilic nuclear organizer region (AgNOR) on prostate cancer proliferation, few studies have evaluated the diagnostic importance of these markers. Therefore, the present study was carried out to analyze the diagnostic value of the proliferative markers cyclin D1 and AgNOR in various prostatic lesions and to determine whether any association or relation between these markers and different Gleason grades exists.
Methods:
A total 50 cases of various prostatic lesions were studied. Tumor grade, AgNOR staining, and cyclin D1 expression were evaluated in all cases. Correlations between the intensity and differential localization of these markers and Gleason grades were evaluated.
Results:
The mean AgNOR count in cases of prostatic intraepithelial neoplasia was high compared with cases of benign prostatic hyperplasia (BPH) but lower than that of carcinoma cases. The intensity of cyclin D1 expression was high in carcinoma. A total of 14 cases (46.67%) showed strong positivity. No significant correlation was found between the intensity of cyclin D1 expression, AgNOR count, and histologic grades of prostatic carcinoma, whereas a significant correlation was observed between intensity and percentage expression of cyclin D1 in BPH and carcinoma (P<0.01). Nuclear as well as cytoplasmic positivity was seen among various grades of carcinoma.
Conclusions:
AgNOR count and cyclin D1 may be helpful in distinguishing between BPH and carcinoma of the prostate but may not be used as reliable indicators of the grade of prostatic adenocarcinoma because of overlapping values in various grades. However, further studies on larger samples are required to elucidate the role of these markers in identification of premalignant lesions.
doi:10.12954/PI.14041
PMCID: PMC4099400  PMID: 25032195
Prostate; Carcinoma; Prostatic hyperplasia; Cyclin D1; AgNORs; Immunohistochemistry
8.  Down Regulation of FOXO1 Promotes Cell Proliferation in Cervical Cancer 
Journal of Cancer  2014;5(8):655-662.
The Forkhead transcription factor FOXO1, an important downstream target of phosphatidylinositol-3-kinase (PI3K)/AKT signaling pathway, regulates cellular homeostasis by maintaining cell proliferation, apoptosis and viability in normal cells. Though, the function and regulation of FOXO1 is well documented in many cancers, the molecular mechanism of its regulation in cervical cancer is largely unknown. In the present study we have investigated the role of PI3K inhibition on FOXO1 regulation. Expression profiling of primary tumors and cell lines show over expression of PIK3CA and AKT1; and down regulation of FOXO1. Lack of FOXO1 promoter methylation and inability of hypomethylating drug 5-Aza-2'-deoxycytidine and HDAC inhibitor trichostatin A to reactivate FOXO1 expression suggest that loss of FOXO1 expression is due to mechanisms other than promoter methylation/acetylation. Inhibition of PI3K by LY294002 decreased the level of p-AKT1 and activated FOXO1 transcription factor. We demonstrate that activation of FOXO1 induces apoptosis, cell proliferation arrest, and decreased cell viability in cervical cancer cell lines. Our data suggest that frequent down regulation of FOXO1 and its functional inactivation may be due to post-translational modifications in cervical cancer. Together, these observations suggest that activation of FOXO1 and its nuclear sequestration is critical in the regulation of cell proliferation, cell viability and apoptosis in cervical cancer. Hence, PI3K/AKT pathway may be a potential molecular target for cervical cancer therapy.
doi:10.7150/jca.6554
PMCID: PMC4142327  PMID: 25157276
Cervical cancer; PI3K/AKT; FOXO1; LY294002; Apoptosis.
9.  A newer variant of congenital pouch colon with rectal agenesis: management strategy and review of the literature 
BMJ Case Reports  2011;2011:bcr1220103635.
A 3-day-old male baby presented with clinico-radiological features of rectal atresia with colo-urinary fistula. There was no radiological evidence of congenital pouch colon (CPC), but per-operatively CPC of unusual anatomy was found. The CPC was intermediate between type I and type II of Narsimha’s classification. The pouch had rudimentary appendix and proximal colovesical fistula. The distal end of CPC was free. In the first stage, diverting ileostomy was done. In follow-up, after 1 month because of rectourinary fistula baby developed hyperchloremic metabolic acidosis and uremic sepsis. First metabolic correction and control of sepsis were done. Thereafter, abdomino-posterior saggital approach was used for excision of colovesical fistula, appendectomy, coloplasty and colorectal anastmosis. The ileostomy was left undisturbed. The infant at present is waiting for the third stage ileostomy closure.
doi:10.1136/bcr.12.2010.3635
PMCID: PMC3176379  PMID: 22679056
10.  Mass Production of the Beneficial Nematode Heterorhabditis bacteriophora and Its Bacterial Symbiont Photorhabdus luminescens 
Indian Journal of Microbiology  2012;52(3):316-324.
Entomoparasitic nematodes (EPNs) are being commercialized as a biocontrol measure for crop insect pests, as they provide advantages over common chemical insecticides. Mass production of these nematodes in liquid media has become a major challenge for commercialization. Producers are not willing to share the trade secrets of mass production and by doing so, have made culturing EPNs extremely difficult to advance existing technologies. Theoretically, mass production in liquid media is an ideal culturing method as it increases cost efficiency and nematode quantity. This paper will review current culturing methodologies and suggest basic culturing parameters for mass production. This review is focused on Heterorhabditis bacteriophora; however, this information can be useful for other nematode species.
doi:10.1007/s12088-012-0270-2
PMCID: PMC3460116  PMID: 23997319
Beneficial nematodes; Photorhabdus luminescens; Heterorhabditis bacteriophora; Mass production
11.  Characterization of Photorhabdusluminescens Growth for the Rearing of the Beneficial Nematode Heterorhabditis bacteriophora 
Indian Journal of Microbiology  2011;52(3):325-331.
Culturing the bioluminescent bacterium Photorhabdus luminescens in nutrient broth (NB) is used to recover phase I cells. These phase I cells were highly luminescent for up to 7 h in this media and the luminosity could also be seen with the naked eye after a 15 min eye adjustment period in a dark room. Red pigmentation is a known trait of phase I cells and was visually distinct within the culture media. The color shade of the red pigment varied on nutrient agar and in NB suggesting that the concentration of the pigment produced is dependent upon density of phase I cells within a specified area. The specific growth rate (μ) and doubling time (g) was determined during the logarithmic growth phase to be 0.36 h−1 and 2.1 h, respectively in NB medium. The nematode-bacterium suspension was injected into larvae of Galleria mellonella to test for entomopathogencity. Within 24 h post-injection insect mortality was seen along with dark red pigmentation and extremely high luminosity indicating infection with P. luminescens.
doi:10.1007/s12088-011-0238-7
PMCID: PMC3460131  PMID: 23997320
Photorhabdus luminescens; Biomass; Specific growth rate; Bioprocessing; Bioluminescence; Entomopathogenic nematodes
12.  Association of anorectal malformation with duplicated colon, sacral meningomyelocele and scrotal anomalies 
BMJ Case Reports  2011;2011:bcr1220103632.
A 3-day-old male baby presented with anorectal agenesis, sacral meningomyelocele (MMC), bifurcated scrotal raphae, abdominal distension and septicaemia. X-ray in the prone position cross table view showed high anorectal malformation. On exploration for colostomy, an 8 cm terminal (sigmoid and descending colon) colonic tubular duplication was found. Both the colonic segments were communicating proximally to each other and distally with urinary bladder, along with complete anorectal agenesis. The excision and repair of the colovesical fistula were done. The colonic segment communicating proximally to the normal colon was exteriorised by window colostomy. The high-resolution ultrasonography of the scrotum revealed two well-developed testis. The bifurcated scrotal raphae and sacral MMC were left to be treated in the future. Unfortunately, the baby died in the immediate postoperative period due to ongoing sepsis.
doi:10.1136/bcr.12.2010.3632
PMCID: PMC3149509  PMID: 22689733
13.  Over Expression of Minichromosome Maintenance Genes is Clinically Correlated to Cervical Carcinogenesis 
PLoS ONE  2013;8(7):e69607.
Minichromosome Maintenance (MCM) proteins play important roles in cell cycle progression by mediating DNA replication initiation and elongation. Among 10 MCM homologues MCM 2–7 form a hexamer and assemble to the pre-replication complex acting as replication licensing factors. Binding and function of MCM2-7 to pre-replication complex is regulated by MCM10 mediated binding of RECQL4 with MCM2-7. The purpose of this study is to explore the role of MCMs in cervical cancer and their correlation with the clinical parameters of cervical cancer. We have investigated sixty primary cervical cancer tissue samples, eight cervical cancer cell lines and thirty hysterectomised normal cervical tissue. The expression profiling of MCMs was done using semi-quantitative RT-PCR, immunoblotting and immunohistochemistry. MCM2, 4, 5, 6, 7, 10 and RECQL4 are significantly over-expressed in cervical cancer. Among these, MCM4, 6 and 10 show increased frequency of over expression along with advancement of tumor stages. MCM4, 5 and 6 also show differential expression in different types of lesion, while MCM2 and MCM10 are over expressed in cervical cancer irrespective of clinico-pathological parameters. Our data indicates the role of MCM4, MCM5, MCM6, MCM10 and RECQL4 in the progression of cervical cancer.
doi:10.1371/journal.pone.0069607
PMCID: PMC3714251  PMID: 23874974
14.  Y-type urethral duplication in children: Management strategy at our center 
Aims:
Report of seven children with Y-type urethral duplication (YUD).
Materials and Methods:
(A) Four staged operations were performed in patients having extensive perineal dissection (for rectourinary fistula separation and anterior mobilization of ventral urethra (VU)), tension rectocutaneous anastomosis, and children who were not toilet trained). These stages are (1) diversion sigmoid colostomy with anterior mobilization of VU as perineal urethrostomy via anterior sagittal approach; (2) Orthotopic urethral (OU) reconstruction; (3) anastomosis of OU and perineal urethra; (4) colostomy closure with management of complications. (B) The patients having VU onto the perineum underwent single stage urethral reconstruction.
Results:
The VU was urethrorectal/urethroanal in five and urethroperineal in two. Low anorectal malformation and upper urinary tract anomalies were present in 57.1% (4/7) and 14.7% (1/7) patients, respectively. Buccal mucosa free graft, transverse inner preputial flap, and perineal skin were tubularized for OU reconstruction. Mean age at 1st , 2nd , 3rd , and 4th surgery was 5 ± 0.78, 28 ± 0.78, 36 ± 0.78, 49 ± 0.78 months respectively. Three patients needed surgery for complications (urethrocutaneous fistula in two and urethral diverticulum in one) in a mean 3.12 ± 0.34 years of follow-up. Final uroflowmetry and fecal continence were good in all patients.
Conclusions:
The YUD is a difficult entity to manage. Although, staged procedure appears to be time consuming, but good and promising results can be achieved by staging the procedure.
doi:10.4103/0971-9261.116042
PMCID: PMC3760307  PMID: 24019640
Anourinary fistula; perineal urethrostomy; rectourinary fistula; urethral duplication; Y-type urethral duplication
15.  Complicated Rapunzel syndrome mimicking intussusception 
BMJ Case Reports  2011;2011:bcr0820103277.
A 5-year-old girl presented with a 3-day history of pain and distension of abdomen, bilious vomiting, bleeding per rectum and a hard lump in the left iliac fossa. Intussusception was clinically diagnosed. On exploratory laparotomy, trichobezoar showing cast of the stomach, duodenal C-loop and tail were extracted. The stomach cast was impacted at the distal ileum, while its tail traversed the ileum, ileocecal valve and extended up to the hepatic flexor. At the site of impaction, a large ileal perforation, covered by bezoar was present. Hence, x-ray did not reveal pneumoperitoneum. There was no evidence of trichobezoar in the stomach. Perforation was exteriorised as loop ileostomy. She was of normal intelligence. Psychological evaluation of the child was performed and a behaviour therapy was advocated. Ileostomy closure was done after 2 months. At 6 months follow-up, no recurrence was found.
doi:10.1136/bcr.08.2010.3277
PMCID: PMC3105568  PMID: 22696764
16.  Chordee without hypospadias: Operative classification and its management 
Urology Annals  2013;5(2):93-98.
Context:
Developing countries.
Aims:
To propose a operative classification of Chordee without hypospadias (CWH) with its management.
Settings and Design:
Tertiary referral centre; Retrospective study from January 2000 to January 2011.
Materials and Methods:
Total 26 patients were classified peroperatively into sixtypes (A: Cutaneous chordee→ Degloving skin and dartos (1/26); B: Fibrous chordee→ chordectomy (4/26);C: Corporocavernosalchordee→ Corporoplasty ± Urethral mobilization (4/26); D: Urethral tethering with Hypoplastic urethra→ Urethral mobilization ± urethral reconstruction because of hypoplastic urethra (14/26); E: Congenital short urethra→ excision of urethra from the meatus and urethroplasty (2/26); and F: Complex chordee→ Degloving ± Corporoplasty ± urethroplasty (1/26 patients). The follow-up over 6 months to 9 years were analyzed.
Statistical Analysis:
SPSS soft ware version 17.0 for Windows.
Results:
The mean age of surgery was 5.33 ± 0.11 years. The success rate defined on uroflowmetry and voiding cystourethrography was 65.6%. The coronal urethra-cutaneous fistula developed in 26.9% (7/26) {including 7.7% (3/26) of associated metal stenosis}. The urethral stricture developed in 3.8% (1/26).
Conclusions:
CWH needs stepwise surgical management. The operative classification may help in better understanding and management of this difficult entity. Meticulous tissue handling and urethroplasty is needed for good and promising results.
doi:10.4103/0974-7796.110005
PMCID: PMC3685753  PMID: 23798865
Chordee without hypospadias; congenital short urethra; hypospadias; hypospadias sine hypospadias
17.  Immature extragastric teratoma of infancy: a rare tumour with review of the literature 
BMJ Case Reports  2011;2011:bcr1220103674.
A full term otherwise healthy, 4-months-old male infant presented with progressive distension of abdomen from 2 months. The clinical examination showed shifting dullness only but no definite lump palpable. The abdominal radiography revealed calcification in right hypochondrium. Serum α-feto protein (AFP), neuron specific enolase, β human chorionic gonadotrophin and urinary vanillymandelic acid (VMA) were appropriate for age-range. Contrast enhanced abdominal CT showed predominantly multicystic lesion in right hypochondrium with central solid component and calcification, but no definite organ of origin determined. The exploratory laparotomy showed extra gastric multilobulated cystic mass sized 23×15×8 cm lesion arising from the lesser curvature of body of stomach. The tumour was feeding through short pedicle based on left gastric artery. There was no infiltration to adjacent areas. Histopathology of excised specimen showed immature teratoma. The child was discharged with appropriate advice and had no recurrence in 1 year of follow-up.
doi:10.1136/bcr.12.2010.3674
PMCID: PMC3070927  PMID: 22700350
18.  Chloroma of Perianal Region Masquerading as Perianal Abscess 
Chloroma, also called granulocytic sarcoma (GS) or Myeloid Sarcoma, is a rare malignant extra-medullary neoplasm of myeloid precursor cells. It is usually associated with myeloproliferative disorders but its appearance may precede the onset of leukaemia. The presence of a chloroma is certainly a sign of poor prognosis. We report a case of chloroma in a middle aged female without a prior history of leukemia in the perianal skin region with clinical diagnosis of perianal abscess. When there is no concomitant leukaemia, diagnosis of chloroma may be difficult. Differential diagnoses include acute lymphoblastic leukemia, large cell NHL, lymphoblastic lymphoma, Ewing's sarcoma and cutaneous T cell lymphoma.
doi:10.4103/0019-5154.105326
PMCID: PMC3555391  PMID: 23372230
Chloroma; granulocytic sarcoma; leukemia; myeloid sarcoma
20.  Tuberculoma of the Tongue Presenting as Hemimacroglossia 
Case Reports in Medicine  2012;2012:548350.
The underdiagnosis of extrapulmonary tuberculosis lesions, along with an emerging global resistance to antitubercular drugs, warrants an increased awareness of the involvement of Mycobacterium tuberculosis in atypical lesions of oral cavity. Tongue is the most common site of oral tuberculosis. We report a rare presentation of lingual tuberculosis in a 65-year-old male, a chronic tobacco chewer, who came to us with swelling of the tongue which apparently looked like hemimacroglossia, leading to the clinical diagnosis of submucosal carcinoma of tongue. Enlargement of tongue is a slow process resulting from gradual invasion and lodging of bacilli in the tongue. Biopsy and histopathological examination revealed tuberculous etiology of the lesion and the patient responded well to antitubercular therapy.
doi:10.1155/2012/548350
PMCID: PMC3538444  PMID: 23319955
22.  Esophageal atresia associated with anorectal malformation: Is the outcome better after surgery in two stages in a limited resources scenario? 
Aims:
To analyze whether outcome of neonates having esophageal atresia with or without tracheoesophageal fistula (EA±TEF) associated with anorectal malformation (ARM) can be improved by doing surgery in 2 stages.
Materials and Methods:
A prospective study of neonates having both EA±TEF and ARM from 2004 to 2011. The patients with favorable parameters were operated in a single stage, whereas others underwent first-stage decompression surgery for ARM. Thereafter, once septicemia was under control and ventilator care available, second-stage surgery for EA±TEF was performed.
Results:
Total 70 neonates (single stage = 20, 2 stages = 30, expired after colostomy = 9, only EA±TEF repair needed = 11) were enrolled. The admission rate for this association was 1 per 290. Forty-one percent (24/70) neonates had VACTERL association and 8.6% (6/70) neonates had multiple gastrointestinal atresias. Sepsis screen was positive in 71.4% (50/70). The survival was 45% (9/20) in neonates operated in a single stage and 53.3% (16/30) when operated in 2 stages (P = 0.04). Data analysis of 50 patients revealed that the survived neonates had significantly better birth weight, better gestational age, negative sepsis screen, no cardiac diseases, no pneumonia, and 2-stage surgery (P value 0.002, 0.003, 0.02, 0.02, 0.04, and 0.04, respectively). The day of presentation and abdominal distension had no significant effect (P value 0.06 and 0.06, respectively). This was further supported by stepwise logistic regression analysis.
Conclusions:
In a limited resources scenario, the survival rate of babies with this association can be improved by treating ARM first and then for EA±TEF in second stage, once mechanical ventilator care became available and sepsis was under control.
doi:10.4103/0971-9261.98123
PMCID: PMC3409897  PMID: 22869975
Anorectal malformation; esophageal atresia; neonatal intensive care; tracheoesophageal fistula
23.  Unusual form of squamous cell carcinoma of the cervix extending in situ into the endometrium: Three case reports and review of literature 
Squamous cell carcinoma of the cervix is the most common gynecological malignancy in India. Direct extension from a cervical growth can involve the uterine corpus, but a superficial spread, without invasion of the underlying myometrium, is uncommon. We report three cases of squamous cell carcinoma of the cervix, with superficial extension to the whole endometrial cavity, by expansile intraepithelial growth. Clinically, two of our cases presented with pyometra and one with vaginal bleeding and discharge. The tumor had spread superficially into the entire endometrial cavity, up to the fundus, replacing the columnar epithelium totally. This was a rare phenomenon, with fewer than 30 cases reported in literature.
doi:10.4103/2229-516X.106359
PMCID: PMC3678696  PMID: 23776829
Cervical intraepithelial neoplasia; cervix; endometrium; superficial spreading

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